【摘要】：目的:本研究通過觀察腹腔鏡下經腹膜前疝修補術(laparoscoplc trans-abdominal preperitoneal hernia repair,TAPP)治療腹股溝嵌頓疝的臨床效果,為臨床治療腹股溝區(qū)嵌頓疝提供參考手術方式。方法:選取青海大學附屬醫(yī)院腹部腔鏡外科2012年11月至2014年10月腹股溝嵌頓疝患者65例,A組:20例(行腹股溝嵌頓疝腹腔鏡下復位+TAPP);B組:21例(行腹股溝嵌頓疝切開復位+腹股溝疝修補術,OR);C組:24例(行腹股溝嵌頓疝切開復位+疝囊高位結扎,high ligation of hernia sac,HL)。評價指標:三組手術時間、住院時間、術中出血量、術后疼痛發(fā)生率、術后胃腸功能恢復時間、以及并發(fā)癥相關指標比較。結果:所有患者經治療后,均治愈出院。(1)A組手術時間較B組、C組手術時間長(P0.05);(2)A組住院時間、術中出血量、術后下床活動時間、術后胃腸功能恢復時間及止痛藥物使用例數,與B、C組進行比較,差異均有統(tǒng)計學意義(P0.05);(3)三組術后皮下血腫、腹腔感染、陰囊腫脹及切口感染指標比較,差異無統(tǒng)計學意義(P0.05);(4)A組術后復發(fā)率低于B、C組,差異有統(tǒng)計學意義(P0.05);B組復發(fā)率同樣低于C組,差異有統(tǒng)計學意義(P0.05)。結論:腹腔鏡下經腹膜前疝無張力修補術(TAPP)術中可以充分探查腹腔,避免了遺漏壞死的腸管風險,其具有創(chuàng)傷小、術后恢復快、住院時間短及術后復發(fā)率低等優(yōu)勢,因此認為,其是治療腹股溝嵌頓疝的一種安全、有效的術式,臨床上可根據患者的實際情況適時應用。
[Abstract]:Objective: to observe the clinical effect of laparoscopic anterior peritoneal hernioplasty (laparoscoplc trans-abdominal preperitoneal hernia repair,TAPP) in the treatment of incarcerated inguinal hernia, and to provide a reference for clinical treatment of incarcerated inguinal hernia. Methods: from November 2012 to October 2014, 65 patients with incarcerated inguinal hernia in the affiliated Hospital of Qinghai University were selected from 65 patients with inguinal incarcerated hernia. Group A: 20 cases (performed laparoscopic reduction of inguinal incarcerated hernia TAPP) group B: 21 cases (performed inguinal incarcerated hernia resection) Open reduction inguinal hernioplasty (OR) Group C (24 cases with inguinal incarcerated hernia) were treated with open reduction of high ligation of hernia sac and high ligation of hernia sac,HL. Evaluation measures: operative time, hospitalization time, intraoperative bleeding volume, postoperative pain incidence, postoperative gastrointestinal function recovery time, and complications were compared among the three groups. Results: all the patients were cured and discharged after treatment. (1) the operation time of group A was longer than that of group B (P0.05); (2), the amount of bleeding during operation, the time of getting out of bed after operation, the time of recovery of gastrointestinal function after operation and the number of cases using analgesic drugs. Compared with group C, the difference was statistically significant (P0.05); (3). The postoperative subcutaneous hematoma, celiac infection, scrotal swelling and wound infection were not significantly different in group A (P0.05); (4), the recurrence rate of group A was lower than that of group B (P0.05). The recurrence rate of group B was also lower than that of group C (P0.05). Conclusion: laparoscopic transurethral tension-free repair of preperitoneal hernia (TAPP) can fully explore the abdominal cavity and avoid the risk of missing necrotic bowel. It has the advantages of small trauma, quick postoperative recovery, short hospital stay and low recurrence rate. It is a safe and effective method for the treatment of inguinal incarcerated hernia.
【學位授予單位】：青海大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R656.2

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